Setting the Record Straight — The Truth About Dental Therapists

Millions of Arizonans struggle to access the dental care they need to lead healthy, productive lives. People go without care because they cannot afford it, cannot find a dentist who will take their insurance, cannot get to the dentist during weekday working hours, or live in an area where there is a shortage of dentists.

To address this problem, Arizona urgently needs to increase access to quality dental care that does not create additional government programs and cost. A proposal submitted to the Legislature would initiate legislation to authorize use of midlevel dental providers, known as dental therapists, who can help expand opportunities to efficiently and effectively serve patients and increase dentists’ revenue.

Dental therapists are similar to physician assistants or nurse practitioners on medical teams. They receive rigorous training in routine preventive and restorative procedures, such as filling cavities and placing stainless steel crowns. When dental therapists provide routine dental care, dentists can focus on more complicated procedures.

Current gaps in care are costly for the state. When people cannot get dental care, they sometimes visit emergency rooms for relief of their symptoms—an expensive and inefficient use of limited health care dollars. A lack of access to dental care especially affects low-income families, children covered by Medicaid, the elderly, people with disabilities, American Indians, and those living in rural communities.

TRUTH: Arizona suffers from a critical shortage of dentists, especially in lower income urban areas, rural cities and towns, and tribal communities.

ALL of Arizona’s counties contain at least some portion that is designated as a Dental Health Professional Shortage Area.

Today there are over 2.8 million people in Arizona living in a dental shortage area. You may hear that Arizona does not have an access problem. That may be true if you live in Scottsdale. Compare this to 1 dentist for all of Greenlee County, a population of over 9,000 people. (See map below)

Dental therapists often work away from the traditional dental office in locations such as rural clinics, nursing homes, and schools while keeping in touch with their supervising dentists through telehealth technology. Dental therapists can extend access to people who face barriers getting to a traditional dental office. For instance, half of the dental therapists in Minnesota work in rural and remote areas of that state where dentists are scarce.

While we can’t compel dentists to move from Scottsdale to Ajo, Seligman or Peach Springs, we do know that continued efforts to stall innovative, cost-effective solutions will only protect a system where people in rural and underserved areas face long wait times and long travel distances to get to a dentist.

TRUTH: Dental therapists can save the state and patients money.

In areas with high competition, practices could hire dental therapists to lower the cost of providing care, and pass these savings onto consumers in the form of lower prices. Dentists that employ dental therapists are better positioned to join dental plan preferred provider networks, which most often offer a reimbursement rate that is lower than dentists’ fees, and require that dentists pass these lower fees onto their patients. Dental therapists lower labor costs for dental practices, which makes it more feasible for practices to accept discounted payment rates from plans.

There are no government subsidies for dental therapists—no subsidies to the therapists, to the dentists or facilities that hire them, or to the schools that train them.

Dental therapists attend accredited colleges and universities, just like dentists do. If those are public institutions, say ASU or NAU, those state institutions get state funding in addition to tuition dollars—not for training therapists, but as state schools with a legislative appropriation.

If dental therapists treat a Medicaid patient, they get reimbursed for that service, just as a dentist would if she treated a Medicaid patient, only dental therapists would be reimbursed at a lower rate than the dentist—just as reimbursements for nurse practitioners and physician assistants are set at a lower rate than the physician for certain procedures—those reimbursement rates will be determined by Arizona’s Medicaid agency AHCCCS. So, in addition to not requiring a subsidy, these professionals, like other allied health professionals, save the state money.

In a time of limited resources and increased demand for dental care, Arizona must find ways to bring high quality dental care to more people, while stretching Medicaid dollars further, without creating another government-run health care program.

“A greater supply of qualified providers would enhance competition, which can yield lower prices, additional service hours, shorter wait times and innovations in care delivery, as we have seen from the increased use of advanced practice nurses and physician assistants.”
–Marina Lao & Tara Isa Koslov
Director and deputy director, respectively, of the Office of Policy Planning at the Federal Trade Commission
June 1, 2016

It’s time to modernize the delivery of dental care in Arizona. The health care market can benefit from additional providers, and Arizonans need access to safe, affordable dental care.

TRUTH: Studies show that Dentists who employ Dental Therapists serve more patients while maintaining or improving their bottom line.

Studies show that dentists and dental practices who use dental therapists serve more patients while maintaining or improving their overall income.

Even more, dental practices benefit by stretching non-profit and Medicaid funds further, allowing them to provide treatment for more patients with limited resources.

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